Healthcare Provider Details

I. General information

NPI: 1023768660
Provider Name (Legal Business Name): MATHEW ALBERT MCGILLIVRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 N KENDALL DR STE 104W
MIAMI FL
33176-2131
US

IV. Provider business mailing address

120 SW 96TH TER APT 201
PLANTATION FL
33324-2342
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-3876
  • Fax:
Mailing address:
  • Phone: 617-901-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME183198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: